Legislation affecting Medicaid: August 25, 2025 – October 9, 2025

There's a clear divide between Democrats and Republicans on the topic of Medicaid. I don't know if the gulf between the two positions can be bridged.

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If proposed legislation affected both Medicare and Medicaid, it is not included here. This post simply shines a light on how our Senators and Representatives view Medicaid and the people whose health depends on that program.

Seriously — this post brought me to tears.

H.R.5064 - Save our Safety-Net Hospitals Act of 2025. To amend title XIX of the Social Security Act to modify certain limitations on disproportionate share hospital payment adjustments under the Medicaid program.

Introduced August 29, 2025 by Nick LaLota (R-NY). Cosponsored by two Democrats and one Republican. Gives states the option to disburse unused Medicaid funds from prior years to hospitals in their state.

H.R.5094 - Protect Patients from Costly Care Act. To repeal changes to Medicaid cost sharing requirements and the exclusion for orphan drugs under the Medicare Drug Price Negotiation Program.

Introduced September 2, 2025 by Chris Pappas (D-NH). Cosponsored by nine Democrats and no Republicans. Section 71120 of the Big Bad Bill requires states to set up a payment schedule for low-income individuals on Medicaid. Under the Big Bad Bill (Public Law 119-21), no longer will services rendered to Medicaid patients be free. Individuals must pay fees to the state, and the state determines what those fees will be.

Pappas’ bill seeks to repeal Section 71120 of Public Law 119-21.

The orphan drug issue means that those medications will not be subject to price negotiation. Which of course means you and I will pay more. When searching for information about Section 71203 of Public Law 119-21, I ran across the CDC’s Web site. They have a section on this topic. And it’s clear that whoever’s in charge of their site has drunk the Kool-Aid. Read their explanation… which makes it sound like Trump only wants the best for Americans.

H.R.5178 - Sickle Cell Disease Comprehensive Care Act. To amend title XIX of the Social Security Act to enable State Medicaid programs to provide comprehensive, coordinated care through a health home to individuals with sickle cell disease.

Introduced September 8, 2025 by Neal Dunn (R-FL). Cosponsored by twenty-one Democrats and two Republicans. Earl Carter (R-GA) and Gus Bilirakis (R-FL) were the only two Republicans who cosponsored.

In addition to doing what it says it does — ensuring that State Medicaid programs provide comprehensive, coordinated care through a health come to individuals with sickle cell disease, including dental and vision — the bill would add the following instructions to the Secretary of Health and Human Services:

BEST PRACTICES.—Not later than June 30, 2026, the Secretary shall make publicly available on the website of the Centers for Medicare & Medicaid Services best practices for designing and implementing a sickle cell disease-focused State plan amendment, based on clinical practice guidelines for sickle cell disease developed by medical specialty societies and in consultation with sickle cell disease providers and patient advocacy organizations.

I’m sorry. This is not a racial issue. It’s not a partisan issue. 100% of our representatives should have cosponsored this bill and insisted on passage the same day. It’s a no-brainer.

H.R.5364 - STOP FRAUD in Medicaid Act (States Taking On Power For Redressing All Unlawful Deceits in Medicaid Act). To amend title XIX of the Social Security Act to direct State Medicaid fraud control units to investigate and prosecute instances of beneficiary fraud.

Introduced September 15, 2025 by Derek Schmidt (R-KS). No cosponsors. Scratching my head. The laws against Medicaid fraud already exist and those who perpetrate such fraud are being prosecuted.

H.R.5462 - Michelle Alyssa Go Act. To amend title XIX of the Social Security Act to revise the definition of institution for mental diseases under the Medicaid program to exclude from such definition institutions having 36 beds or less if such institutions meet certain standards.

Introduced September 18, 2025 by Daniel Goldman (D-NY). Cosponsored by six Democrats and four Republicans.

From Rep. Goldman’s Web site: The ‘Michelle Alyssa Go Act’ is named after a 40-year-old woman who was tragically pushed to her death in front of an incoming subway train at a stop in Times Square. After the attack, a 61-year-old man experiencing homelessness with diagnosed Schizophrenia named Martial Simon admitted to shoving Go in front of the train. According to news reports, after showing signs of schizophrenia in his 30s, Mr. Simon spent time bouncing between hospitals, jails, and outpatient psychiatric programs without ever receiving the long-term care he needed.

While those suffering from mental illness are far more likely to be victims of violence than perpetrators, this tragedy proved a stark reminder of the glaring gaps in our mental health infrastructure that leaves far too many people to fall through the cracks. The bill is supported by Michelle’s father, Justin Go.

“If our country had a more comprehensive and equitable mental health care system, Michelle Go might still be alive today,” Congressman Dan Goldman said. “In the wake of the COVID-19 pandemic, the mental health crisis in America is more dire than ever. More and more, those in desperate need of acute mental health care are unable to receive it, leading to tragic consequences. We have the opportunity to make sure that the tragedy of Michelle Go’s death never happens again by helping those on Medicaid to get the treatment they need. I’ve introduced this legislation to honor Michelle’s memory, close this equity gap in mental health care, lift up our communities, make our streets safer, and ensure that those seeking help can get the care they want.”

Please read Rep. Goldman’s entire message. It is heartbreaking.

H.R.5662 - To amend title XIX of the Social Security Act to remove the exclusion from medical assistance under the Medicaid program of items and services for patients in an institution for mental diseases.

Introduced September 30, 2025 by Shri Thanedar (D-MI). No cosponsors. Text is not yet available. If mental health issues are a legislative matter you care deeply about, I would recommend getting alerts for this bill to see its text and whether it gains traction.

Please comment here if you have additional information on this bill.

H.R.5685 - To amend title XIX of the Social Security Act to increase under the Medicaid program the minimum monthly personal needs allowance for institutionalized individuals and couples.

Introduced October 3, 2025 by Gwen Moore (D-WI). Cosponsored by three Democrats and no Republicans. Text is not yet available. Please comment here if you have additional information on this bill.

No proposed legislation from October 4 – October 9, 2025.

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